Outsmarting Pregnancy Allergies

Hay fever season runs from August through October. Because of the ragweed pollen and mold spores in the air, you may experience nasal congestion, sneezing, a runny nose, or itchy or red eyes. These symptoms only add to the normal congestion caused by pregnancy-related swelling of the nostrils.

Normally, the immune system responds to a threat, such as harmful bacteria, by releasing chemicals to destroy it. Allergies occur when your immune system reacts the same way to harmless substances such as pollen or animal dander.

Your first line of defense is to avoid contact with substances that trigger your allergies. If you're allergic to pollen or mold, for example, follow these steps to reduce your exposure:

Instead of opening windows, use air-conditioning. Clean the filter in your home unit once a month until the end of October.

Avoid outdoor activities when the pollen count is high (check local levels at aaaai.org).

Change clothes after spending time outdoors, and shower to remove pollen from hair and skin.

Don't hang sheets and clothing outside to dry.

Have someone else rake leaves or mow the lawn.

If you're a seasonal allergy sufferer, your symptoms will likely pass as winter nears. But if you're sniffling year-round, you're probably irritated by indoor allergens. Common culprits are mold, dust mites, roaches, and pet dander. You can reduce your exposure by using a vacuum with a HEPA filter.

Also keep pets, if you have them, out of your bedroom. And bathe your pet once a week to reduce its dander.

Since you spend about a third of your day in your bedroom, take steps to reduce the number of dust mites there. Encase pillows and mattresses in covers that protect against dust mites, and wash bedding in water that is 130 degrees F. each week. Also, choose window shades instead of blinds, remove carpeting, and mop floors and windowsills weekly. Dust mites flourish when your home is warm and humid, so buy a humidity monitor to determine if you need a humidifier or dehumidifier (the humidity level should be between 30 and 50 percent).

If your allergies interfere with eating or sleeping, you may want to discuss medication with your doctor. Although it's best to avoid unnecessary drugs during the first trimester, many allergy medications are safe during the last six months.

A nasal spray can ease congestion and won't hurt you or your baby. Your doctor may also recommend an antihistamine or a decongestant. Chlor-Trimeton is one of the safest nonprescription antihistamines but can cause drowsiness. Nonsedating antihistamines such as Claritin and Zyrtec are safe for pregnant women and are also available without a prescription.

Many doctors recommend Afrin, an over-the-counter nasal spray. Little, if any, of the drug is absorbed into your system, which makes it a good choice. Over-the-counter allergy-blocking nasal sprays such as NasalCrom are also considered safe, as are prescription nasal steroids like Nasacort AQ.

If you're already getting allergy shots, it's okay to continue them. You should not, however, start shots during pregnancy, because there's a slight risk of a serious allergic reaction.

Between 4 and 8 percent of pregnant women have asthma, a respiratory condition in which the airways become narrowed when exposed to certain triggers. Symptoms include wheezing, chest tightness, shortness of breath, and persistent coughing. It's important to control your symptoms: If you're not getting enough air, neither is your baby.

About 70 percent of people with asthma also have allergies. Asthma triggers include cold air, exercise, strong odors, and lung irritants such as secondhand smoke.

Poorly controlled asthma can deprive your baby of oxygen, increasing the risk of premature delivery, poor growth, and low birth weight. It can also contribute to preeclampsia, a form of high blood pressure that can result in poor fetal growth and premature birth.

Fortunately, most asthma medications are safe during pregnancy. If you have occasional, mild symptoms, you'll likely need treatment with an inhaled bronchodilator spray such as Ventolin only during flare-ups. If you have persistent mild to severe symptoms, your doctor may recommend an inhaled steroid, such as Pulmicort. Some women with moderate to severe symptoms might need a long-acting bronchodilator such as Serevent.

Doctors prefer to treat asthma with inhaled meds because very little of the drug reaches the fetus. However, if these don't effectively control your asthma, you can opt to take an oral steroid such as prednisone until symptoms are under control.

The severity of your symptoms may change during pregnancy. Studies suggest that they worsen in about one-third of pregnant women, improve in one-third, and remain unchanged in the others. Many asthma patients experience heartburn, and although the connection is unclear, heartburn may cause symptoms to worsen. To ease your heartburn -- and your asthma -- sleep with your head elevated, eat small and frequent meals, avoid food within two hours of bedtime, or take an over-the-counter antacid.

Allergy and asthma symptoms can cause discomfort but in most cases won't hurt your baby. Take your asthma and allergy medications as directed, and avoid triggers to ease your symptoms and reduce your need for medication.

If you have symptoms but aren't sure what triggers them, getting tested can make your treatment more effective. Here's what experts have to say about allergy tests while you're pregnant.

This test, also called RAST, is completely safe for Mom and baby. "It's performed outside of the body, and therefore there's no risk of an allergic reaction," says Mike Tingale, spokesperson for the Asthma and Allergy Foundation of America. It's pretty simple -- a small amount of blood (think one test tube) is drawn. Using this sample, clinicians check for about 20 allergens; you get results within a few days. Most insurance companies cover the test, but check in advance to be sure.

A small needle is used to make a series of shallow scratches on the forearm, which are then exposed to potential allergens. If you're allergic to a substance, the test site will become red and swollen. This test is generally considered safe for pregnant women, but there's a slight chance of a reaction -- including hives, shortness of breath, or closing of the throat. For this reason, many allergists don't perform it on pregnant women.
--Jessica Wohlgemuth

Originally published in the September 2008 issue of American Baby magazine.

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